For couples that have tried in vain for months -- sometimes years -- to conceive a child, the diagnosis of infertility is usually met with a barrage of emotions. The most intense of all is often confusion, as a maze of p

Dr John J. Stangel

For couples that have tried in vain for months -- sometimes years -- to conceive a child, the diagnosis of infertility is usually met with a barrage of emotions. The most intense of all is often confusion, as a maze of possible problems and potential solutions spurs more questions than answers. "Is it me, or is it him, or is it both of us? Will I have to take drugs, or have surgery? Do I need a specialist? Is In Vitro Fertilization (IVF) our only choice? Where do we start?""The field of reproductive medicine has made rapid and incredible advances over the past decade in the area of infertility treatment options, and now the vast majority of infertile couples can achieve a successful pregnancy," says Dr. John J Stangel, Westchester County Medical Director of Reproductive Medicine Associates of Connecticut. Dr Stangel, co-author of the new book, The Unofficial Guide to Getting Pregnant, adds, "But a huge amount of new information has left many couples to navigate a maze that seems to be intimidating." This can lead to emotional frustration from not knowing which path to choose, physical discomfort from unnecessary or inappropriate treatments, and even financial troubles from the cost of treatment and the confusion over insurance coverage, notes Dr Stangel.

"Fortunately, although the sea of infertility solutions is vast and deep, there is a step-by-step system that simplifies the process of determining which path is right for each individual couple," says Dr Stangel. "The first step, of course, is to consult a reproductive specialist -- a medical doctor, often an obstetrician, trained and board certified in Reproductive Medicine and infertility," he adds.

Then, after the following five steps, an infertile couple is usually on their way to a healthy, successful pregnancy:

Step 1: The fertility workupThis exam is the crucial first step for couples requiring treatment for infertility. Both mom-to-be and dad-to-be participate, and the questions range from the mundane ("How old are you?" and "Have you ever had a child?") to the complex ("Did your mother take Diethylstilbestrol [DES] when she was pregnant with you?" and "Have you ever had chemotherapy or radiation to treat cancer, and if so, what specific drugs were used?"). Dr Stangel says, "A physical examination, along with discussion of medical histories, lifestyle histories, timing of intercourse and even choices of undergarments for dad-to-be are fair game during the workup." This is also a good time to ask specific questions, or to tell your doctor about anything you suspect might pertain to your infertility.

Step 2: The hormone checkWhile In Vitro Fertilization and other Assisted Reproductive Technologies (ARTs) tend to get most of the attention, the fact is that only 3% of infertile couples require IVF or other ARTs to conceive. "The great majority of female infertility can be attributed to hormone imbalances," Dr. Stangel notes. "When this is the case, there are a number of drug and hormone therapies available to normalize the hormone levels, and even some lifestyle options like weight loss or weight gain that may help regulate a woman's cycle to help conception along," he adds.

Step 3: The sperm checkMotility, viscosity, quantity, quality -- the possible problems with sperm are a contributing factor in nearly half of all infertile couples' inability to conceive. "A lab experienced at doing semen analysis should evaluate the sperm. The lab results should be interpreted by a urologist, andrologist or reproductive endocrinologist � each experienced with this type of study," Dr. Stangel urges. Again, there are a number of lifestyle- related fixes for sperm issues, as well as several drug and hormone therapies available.

Step 4: The structural inspectionAlong with the above studies, specialists move to the structure of both the male and female reproductive systems. Troubles in this area include blocked fallopian tubes, uterine malformations and even problems with the penile and seminal structures. "Most of the time, if there is a structural problem surgery is needed to correct these issues in order to achieve a pregnancy," says Dr Stangel.

Step 5: Exploring the ARTsIn the event that the first four steps don't result in pregnancy, Assisted Reproductive Technology can help. From In Vitro Fertilization, ZIFT, GIFT and TET procedures to promising new techniques for maturing eggs outside the womb and cryopreservation of human eggs, the ARTs are helping tens of thousands of couples each year to achieve a healthy, successful pregnancy. Originally designed for women with damaged fallopian tubes, ART is now used to address every conceivable fertility issue, with an average success rate of about 30 percent per attempt.

"While it can be overwhelming at times, with the right guidance, the maze of infertility can be a journey of hope and, ultimately, happiness for couples wishing to have a child," concludes Dr Stangel.